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USE
PERMIT
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CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER AME/NAME OF BUSINESS
Z MAILIN ADDRESS
0 O 311 NJN1�IG Uf 80 DA .
A (�%
CITY M 0��� � I t 902 TE� 4 �E NUMBEW7e%
NAME ' ��5HY4
ENUMBER
NAME
CITY ZIP TELEPHONE NUMBER
IRC
STATE LICENSE NUMBER
Legal Description of Property - include all easements
(show below or attach two copies)Q . b Tit S b w l. O�ET Tkt
JOB
ADDRESS 3 / J vz ylnlo/G llleil t6
LEGAL DESCRIPTION CHECK SUBDIVISION NO. ILID NO.
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP. TESCP
APPROVED BY
EXISTING REQUIRED DEDICATION
PROPOSED _
RIGHT OF WAY CONSTRUCTION PERMIT REQUIRED ❑
STREET USE PERMIT REQUIRED ❑
SEE ENGINEERING MEMO DATED
REMARKS
SIZE
REMARKS
SUPPLY SIZE
SIGN AREA
ALLOWED i PROPOSED
ENV. REVIEW
COM� EXEMPT
UNITS
VARIANCE OR CU( LANNING REVIEW`ff `
QQ ff� 3 SETBACKS — FEET T LOT
T8X KC .074 Paral dO. YY FRONT SIDE (0 REAR
�% 0 I4 ,�b� , I �0 2 CWI REMARKS
tttJJ���.L[L., tr-� W / %..
NEW RESIDENTIAL El PLUMBING
IADDIALTER El COMMERCIAL 0 MECHANICAL
REPAIR El APT. BLDG. I__.J SIGN
EXCAVATE, F]FILL
DEMOLISH OR GRADE ❑ I. PENCE x —FT)
swim
REMODEL GARAGET POOL
❑ WOOD STOVE/ ❑ RETAINING WALL/
INSERT ROCKERY RENEWAL
(TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN:
NUMBER OF OF STORIES NUMBER OF
I DWELLING I
UNITS
NATURE OF WORK TO BE DONE (ATTACH PLOT PLAN)
FAQ 11.nSG
D BY I TYPE OF
HEIGHT
SPECIAL INSPECTOR AREA OCCUPANCY OCCUPANT
REQUIRED GROUP LOAD
FIYES NO YES NO 4�r�
REMARKS
PROGRESS INSPECTIONS PER UBC 305
FINAL INSPECTION REQUIRED
VALUATION
PLAN CHECK FEE
BUILDING
PLUMBING
Plan Check No. 7 MECHANICAL
This Permit covers work to be done on private property ONLY. GRADINGIFILL
Any construction on the public domain (curbs, sidewalks,
driveways, marquees, etc.) will require separate permission. STATE SURCHARGE
Permit Application: 180 Days
Permit Limit: 1 Year • Provided Work is Started Within 180 Days
"Applicant, on behalf of his or her spouse, heirs, assigns and
N successors in interest, agrees to indemnify, defend and hold
J harmless the City of Edmonds, Washington, its officials,
employees, and agents from any and all claims for damages of
Cr
whatever nature, arising directly or indirectly from the issuance PLAN CHECK DEPOSIT
0 of this permit. Issuance of this permit shall not be deemed to
0 modify, waive or reduce any requirement of any city ordinance
° nor limit in any way the City's ability to enforce any ordinance TOTAL AMOUNT DUE
provision."
I hereby acknowledge that I have read this application; that the ATTENTION
information given is correct; and that I am the owner, or the duly
Lhe agent of the owner. I agree to comply with city and THIS PERMIT
regulating construction; and in doing the work authoriz• AUTHORIZES
, no person will be employed in violation of the Labor ONLY THE
e State of Washington relating to Workmen's Compensa• WORK NOTED
nce. INSPECTION
OW ER OR AGENT) DATE SIGNED DEPARTMENT
/ Z
I�qoP �CITY OF
EDMONDS
CALL FO
ATTENTION INSPECTION
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE 771=3202
UNTIL A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR /
A CERTIFICATE OF OCCUPANCY HAS BEEN GRANTED. UBC
CHAPTER 3.
102•B7
APPLICATION APPROVAL
This application is not a permit until
signed by the Building Official or his
Deputy; and fees are paid, and receipt is
acknowledged in space provided.
OFFICIAL'S SIGNATURE DATE
RELEASE nc ATE
6414 �o
ORIGINAL — File YELLOW — Inspector
PINK — Owner GOLD — Assessor
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Y890.194
CITY OF EDMONDS
250 • 5TH AVE. N. • EDMONDS. WA 98020 • (206) 771.3202
COMMUNITY SERVICES:
Public Works • Planning • Parks and Recreation • Engineering
LETTER OF TRANSMITTAL
Date: b/zAl
To:
Project: qq '�/�
Address: /�!j %y 'A&0 6'�'1' �y
Plan review number:
Transmitting: Plans & Calcs Soils Report Other
For your information: Comments:
4� \r y s requested b your office:
91
For: structural plan review.
r
t7
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1�
LARRY S. NALIGHTEN � -
MAYOR
PETER E• HAHN
DIRECTOR
P its
For non-structural plan review: he � a! lop-�ot47.T47• 0•
For Washington State Energy Code review:
For Northwest Energy Code review:
For Fire Code review.
f
Note attached comments:
For Corrections and resubmittal:
Respond to letter in writing:
Resubmit 2 revised plans.
Send directly to City Building Division:
Building Division
so
�* vAF
City Official
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• Incorporated August 11, 1890 •
Sister Cities International — Hekinan, Japan
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RECORD OF INSPECTIONS14
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DATE APPROVED
INSPECTOR 't
414
SETBACKSIF t
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FOUNDATION:
Footing. I
' 1
Wall ..................
Pier/Porch 4
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Retaining Wall
PLUMBING: , :.
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Underground .......... ,
Rough -In
CF ..............
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HEATING: 1 1
Gas Test...............
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Gas Piping ......: ....
Equipment
CF ....... too ....:......
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FRAMING ............... .�
SHEETROCK NAILING ...
SPECIAL INSPECTION ... �'
FINAL APPROVAL 'rf /16III
FOR OCCUPANCY .......
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